tbuckley/cabot-search huggingface dataset:
Abstract 11088: Childbirth Related Complications in Women With Hypertrophic Cardiomyopathy
Authors: Vikas Yellapu, Leyla Gasimli-Gamache, Amitoj Singh, Jamshid Shirani
Journal: Circulation (2022)

Background. Women with hypertrophic cardiomyopathy (HCM) have higher risk of adverse cardiac events and obstetrics complications with labor and delivery (L&amp;D). Data on HCM and peripartum complications are still scarce. We aimed to examine the maternal cardiovascular and obstetric outcomes of L&amp;D in women with HCM in the United States. Methods. We identified 1,1655 mothers with HCM (age 29.5±6.2 years, 48% Caucasians) admitted to a hospital for childbirth from 2003-2018 according to Nationwide Inpatient Sample database. Results. Mode of delivery was Cesarean section (CS) in [702 (61%)] and mean length of stay was 5.5±6 days. There were two maternal deaths and a low rate of major adverse cardiac events (MACE) including cardiac arrest [n=11 (0.9%)], cardiogenic shock [n=10 (0.8%)], and ventricular tachycardia [n=35 (3%)]. Cardiopulmonary resuscitation, mechanical circulatory support, and temporary venous pacemaker rates were low at 0.75%, 0.4%, and 0.4% respectively. There was an increased rate of ARDS [n=45 (3.9%)], deep veins thrombosis [n=8 (0.7%)] and acute renal failure [n=14 (1.2%)]. Obstetric complications included abruption placenta [n=36 (3.14%)], preterm labor [n=193 (16.8%)], premature rupture of membranes [n=32 (2.8%)], pre-eclampsia/eclampsia [n=166 (14.37%)] and gestational hypertension [n=57 (4.9%)]. Post-partum hemorrhage occurred in [n=26 (2.2%)] of deliveries and maternal blood transfusion was needed in [n=77(6.7%)] of patients. Fetal distress, abnormal fetal heart rate and fetal growth retardation occurred in 5.5%, 9.8% and 1.3%, respectively. Conclusions. We were able to identify that there has been an increase in the number HCM over the past decade, however, there has been a decrease in maternal and fetal complications.
Abstract 12725: Sarcopenia With Low Serum Albumin is Associated With Worse Prognosis in Patients Hospitalized for Acute Decompensated Heart Failure
Authors: Saeid Mirzai, Ian Persits, Kunaal Sarnaik, Jerry Estep, Po-Hao Chen, Wai Hong W Tang
Journal: Circulation (2022)

Introduction: Low serum albumin is a marker of protein malnutrition and is commonly associated with worse outcomes in various clinical settings. Furthermore, significant overlap exists between malnutrition and sarcopenia, which can be an independent predictor of worse outcomes. Hypothesis: We assessed the hypothesis that the presence of sarcopenia with low albumin (SLA) would lead to synergistically worse outcomes in patients with acute decompensated heart failure (ADHF). Methods: Patients hospitalized for ADHF from 2017 to 2019 with computed tomography of the abdomen/pelvis within 30 days and albumin level within 24 hours before discharge were studied (n=181). Given the high prevalence of hypoalbuminemia, low albumin was defined as the lower fiftieth percentile. Semi-automatic measurements of skeletal muscle area were made at L3 (Figure 1A) and adjusted using height squared to obtain skeletal muscle index (SMI). Sarcopenia was defined as the lowest sex-stratified SMI tertile. Results: The prevalence of sarcopenia alone was 11.6%, low albumin alone 28.7%, and SLA 20.4%. The groups had similar demographics but differed in BMI (lowest in sarcopenia alone, p&lt;0.001) and admission NT-proBNP (highest in SLA, p=0.029). Patients with SLA were discharged to facilities most often (55.2%, p&lt;0.001). All-cause mortality differed among the groups (p&lt;0.001) during a median follow-up of 23.4 (4.2-45.0) months (Figure 1B). Compared to controls, those with SLA were at the highest risk (HR 2.46, 95%CI 1.50-4.02, p&lt;0.001), followed by patients with low albumin alone (HR 1.77, 95%CI 1.11-2.83, p=0.016) or sarcopenia alone (HR 1.73, 95%CI 0.93-3.20, p=0.082), the latter not reaching significance. Conclusions: In conclusion, sarcopenia with low serum albumin is associated with higher mortality. Available resources and interventions should be utilized during ADHF hospitalization to optimize nutrition for these patients.
Abstract 12654: Reduction of Tricuspid Regurgitation as Predictor of Successful Percutaneous Edge-to-Edge Repair: Clinical Outcomes Comparison Between Patients With Residual Severe and Moderate-or-Less Regurgitation
Authors: Alexandru I Patrascu, Ilka Ott
Journal: Circulation (2022)

INTRODUCTION: Transcatheter tricuspid valve repair (TTVR) for high-grade regurgitation (TR) is emerging as a viable option, but defining procedure-related clinical success is challenging, as considerable reduction is not possible in all patients with massive or torrential TR. This study compared clinical outcomes of edge-to-edge TTVR, in patients with residual severe vs moderate-or-less TR. Methods: Eligible patients had chronic symptomatic functional TR despite diuretic therapy, and were deemed inoperable by the local Heart Team. TR was assessed by the current five-grade classification. Efficacy and safety outcomes were compared at baseline and 6 months, with follow-up between January 2021 and May 2022. Results: Forty-three patients had ≥severe (III/V) functional TR, 65% presenting with massive (IV/V) and 14% with torrential (V/V) TR. Mean age was 81.8±4.9 years, with 10.8±6.3% STS-Score. The primary efficacy endpoint of at least one-grade TR reduction was recorded in 91% of all patients, with no device related complications.Residual severe TR (STR subgroup) was present in 15 patients, while 20 (MTR subgroup) had moderate-or-less (≤II/V). By 6 months, 4 patients died, 4 patients had no TR reduction, and MACE rate was 18.6%. Improvement in initial NYHA class III/IV occurred in 61% of STR and 77% of MTR patients. KCCQ Score increased by 17±10.6 pts. (p&lt;0.001) vs 21±11.8 (p&lt;0.001), and six-minute walk test by 69.6±48.7 meters (p&lt;0.001) vs 74.2±63 (p&lt;0.001). Renal and liver function equally improved in both groups [GFR 50±16ml/min/1,73m 2 to 57.8±20.4 (p=0.012) vs 57.4±18.5 to 65.5±21.2 (p=0.002); AST 27.5±9.3U/L to 22.9±7.3 (p=0.039) vs 37.2±25.6 to 26.8±7.3 (p=0.069)]. CONCLUSIONS: Although TTVR should always aim for trace to mild TR, considerable reduction is not always possible. This study indicates that even one-grade TR reduction can significantly impact quality of life, functional capacity and multiorgan involvement, similarly in STR and MTR patients.
Abstract 11979: Direct Assessment of Engineered Heart Tissue Field Potential and Contraction Dynamics Using Flexible Electronics Technology
Authors: Dominic E Fullenkamp, Seyong Oh, Yoonseok Park, Ivana A Chychula, Cory W Holgren, Jodi L Curtin, Alexis R Demonbreun, John A Rogers, Elizabeth M McNally
Journal: Circulation (2022)

Introduction: Human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) enable the study of human heart disease in a dish. However, when cultured as cells on plastic, these 2D models are immature and exhibit non-physiologic outputs. When cultured as engineered heart tissues (EHTs or 3D models), hiPSC-CMs display a more mature gene and protein profile. Although multielectrode array (MEA) platforms have been applied to 2D cultures to study the electrical properties of hiPSC-CMs, a similar approach has been lacking for EHTs. We now took advantage of technological advances in flexible electronics to create a 3D platform that allows continuous transduction of field potential and strain of human EHTs. Methods and Results: Using microfabrication techniques adapted from the semiconductor industry, custom ring-shaped flexible electronics constructs were created with 6 support posts. Each post included a microelectrode for recording electrophysiological information and a piezoresistive strain sensor for monitoring EHT contraction dynamics. These were integrated onto a flexible biocompatible polyimide support. hiPSCs were differentiated into hiPSC-CMs, and EHTs were generated by seeding 500,000 cells composed of 90% hiPSC-CMs and 10% human cardiac fibroblasts into a collagen matrix and deposited in the ring-shaped polydimethylsiloxane (PDMS) molds. Tissues were condensed over 7 days and then were transferred onto the flexible electronic scaffolds. Tissues remodeled for ~30 days and then were analyzed for contractile properties. Direct tissue stimulation and field potential measurements were obtained in real time using an Intan RHS stimulation recording system. Simultaneous recording of force of contraction relied on a calibrated Wheatstone bridge circuit. EHTs from hiPSC-CMs displayed appropriate contractile responses to pharmacologic agents. Conclusion: Although EHTs improve hiPSC-CM models by improving cellular maturity, it has been challenging to measure physiological outcomes. We now developed a prototype that simultaneously provides electrophysiologic and contractility characterization in real time of human EHTs.
Abstract 12102: Concomitance of Diabetes Mellitus and Prior Myocardial Infarction Associated With Poor Clinical Outcomes in Patients With Atrial Fibrillation: The Fushimi AF Registry
Authors: Yuya Ide, Hisashi Ogawa, Yumiko Nakanishi, Kimihito Minami, Kenjiro Ishigami, Syuhei Ikeda, KOSUKE DOI, Yasuhiro Hamatani, Takashi Yoshizawa, Akiko Fujino, Mitsuru Ishii, Moritake Iguchi, Nobutoyo Masunaga, Masahiro Esato, Hiromichi Wada, Koji Hasegawa, Mitsuru Abe, Masaharu Akao
Journal: Circulation (2022)

Background : Patients with diabetes mellitus (DM) have high risk of cardiovascular events such as cardiovascular death, stroke, heart failure and so on. Patients with history of myocardial infarction (MI) are also at high risk. The outcomes of patients with nonvalvular atrial fibrillation (NVAF) who have both DM and history of MI are unclear. Methods : From the Fushimi AF registry, we obtained NVAF patients who had both DM and history of MI (DM+MI+: N=107), either DM or history of MI (DM-MI+: N=156, and DM+MI-: (N=935), and neither DM nor history of MI (DM-MI-: N=3,197). Major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause mortality were evaluated. MACCE was defined as composite events of cardiovascular death, myocardial infarction, stroke, and admission for heart failure. Results: The median follow-up period was 1,851 (interquartile range: 790-2,924) days. DM+MI+ patients were often male and had more heart failure, chronic renal disease, dyslipidemia, hypertension, and paroxysmal AF than other patients. DM+MI+patients had also higher risk scores (CHADS 2 , CHA 2 DS 2 -VASc and HAS-BLED scores). DM+MI+ patients had significantly higher incidence (% per patient-year) of MACCE and all-cause mortality than others (Figure A and B. MACCE: DM+MI+ 18.8%, DM-MI+ 8.0%, DM+MI- 6.1%, DM-/MI- 4.9%, log rank P&lt;0.001, all-cause mortality: 10.2%, 6.1%, 5.2%, 4.5%, respectively, log rank P&lt;0.001). In multivariate analysis, DM+MI+ was significantly associated with the incidence of MACCE compared with DM-/MI- (adjusted hazard ratio [95% confidence interval], 1.97 [1.36-2.87], P&lt;0.001), although DM-MI+ and DM+MI had no association with it. In addition, DM+MI+ had no significant association with the incidence of all-cause mortality after multivariate adjustment. Conclusion: Patients with NVAF who have both DM and history of MI had more comorbidities and had significant association with adverse cardiovascular events.
Abstract 12099: Relationship Between Fatigue Subtype and Heart Failure Admission, Quality of Life, and Mortality in Persons With Heart Failure: A Secondary Analysis of the Atherosclerosis Risk in Communities Study
Authors: Noelle Pavlovic, Jeannie-Marie Leoutsakos, Martha Abshire, Cheryl R Dennison Himmelfarb, Sarah Szanton, Chiadi E Ndumele
Journal: Circulation (2022)

Introduction Fatigue is one of the most common and distressing symptoms of heart failure (HF). It consists of two types: general and exertional. Although it’s common, little is known about whether and which type of fatigue is associated with patient reported and clinical outcomes. We conducted a secondary data analysis of the Atherosclerosis Risk in Communities (ARIC) study to determine if fatigue type predicts key patient reported and clinical outcomes in persons with HF. Methods This analysis included 1,068 individuals with a diagnosis of prevalent HF at visit 5 (2011-2013) of the ARIC study with available survey data on general and exertional fatigue. Four fatigue subtypes were identified previously through latent class analysis on general and exertional fatigue survey items in this sample. These fatigue subtypes are: 1) High general &amp; exertional, 2) High general &amp; low exertional, 3) Moderate general &amp; exertional, and 4) Low/No fatigue (reference category). To assess the relationship between fatigue subtype and outcomes, we used latent class regression, regressing HF hospitalization, quality of life (QOL, SF-12 scale) and mortality on fatigue subtype, adjusting for covariates (demographics, clinical comorbidities, and medications). Results Our sample was 54% female and 38% Black, with a mean age of 77 ± 5.5. Those with the high general &amp; exertional fatigue subtype had 2.2 times higher likelihood of HF hospitalization than those with the low/no fatigue subtype (OR = 2.2; 95%CI = 1.2, 4.1). Those with the high general &amp; exertional fatigue subtype had significantly poorer mean physical (50.3 v 64.6, p&lt;0.001) and mental (49.3 v 58.0, p&lt;0.001) QOL than those with the low/no fatigue subtype. Those with the moderate general &amp; exertional fatigue subtype also had significantly poorer physical QOL than the low/no fatigue subtype (61.9 v 64.6, p&lt;0.001). There were no significant differences in mortality between fatigue subtypes. Conclusions Fatigue subtype in persons with HF is associated with HF admissions and quality of life. It will be important to elucidate the pathways underlying the development of fatigue and to determine whether targeting fatigue can improve clinical outcomes.
Abstract 11216: Greater Prognostic Value of Left Atrial Mechanics Compared to Left Atrial Volume in Atrial Functional Mitral Regurgitation
Authors: Dana Cramariuc, Hassan Alfraidi, Yasufumi Nagata, Robert Levine, Carl Andrews, Judy Hung
Journal: Circulation (2022)

Introduction: Atrial functional mitral regurgitation (AFMR) is associated with increased mortality and morbidity. Optimal management however remains unclear. Mechanism of AFMR is linked to left atrial remodeling yet left atrial (LA) size and function are still poorly characterized. Objectives: To assess LA size and function by reservoir strain (LASr) and reservoir work (LAWr) and their impact on outcome in AFMR. Methods: Consecutive patients examined at our institution between 2001-2019 and with AFMR of at least moderate MR degree were examined. LAWr was estimated as LASr x LA reservoir volume, and patients were grouped by median LASr or LAWr. Outcomes were all-cause death or heart failure hospitalizations. Results: 515 patients with moderate or greater AFMR were followed for a median of 5 [range 1-17] years. All patients had previously documented atrial fibrillation (AF) (38%), heart failure with preserved ejection fraction (HFpEF) without AF (24%), or both (HFpEF+AF, 38%). LA volume was largest in AF patients and smallest in HFpEF while LA function parameters were greater in HFpEF and AF compared to the combined HFpEF+AF group (Fig. A,B).During follow-up, patients with low LASr or LAWr had higher risk of death (p &lt;0.001, Fig. C) and heart failure hospitalizations (p&lt;0.05). In Cox regression analyses, low LASr and LAWr, but not LA volume and left ventricular function, were associated with a higher risk of death (LASr: HR 2.3 (95% CI 1.6-3.5); LAWr HR 3.4 (95% CI 2.4-4.7), both p&lt;0.001) after adjustment for clinical and echocardiographic confounders. Conclusion: LA reservoir function but not LA size is a robust predictor of outcome in AFMR with moderate or greater MR. This provides mechanistic insights into the interplay of functional parameters versus LA geometric changes in AFMR.
Abstract 12340: Vascular Pathology of Critical Limb Ischemia; Comparison of Plaque Characteristics Between Anterior and Posterior Tibial Arteries
Authors: Yutaka Koyama, Hiroyuki Hao, Suguru Migita, Sayaka Shimodai-Yamada, Mayumi Suzuki, Kenta Uto, Yasuo Okumura
Journal: Circulation (2022)

Background and aims: The number of patients with peripheral arterial disease (PAD) is increasing, and when it develops into critical limb ischemia (CLI), the 5-year mortality rate is as high as 50%. Nevertheless, there are few histopathological reports of PAD. We analyzed the pathology of anterior tibial artery (ATA) and posterior tibial artery (PTA) obtained from the patients who underwent low extremity amputation due to CLI. Methods: Thirty tibial arteries removed from 15 lower limb amputation specimens were examined. Dissected ATAs and PTAs were subjected to ex-vivo soft X-ray radiography, followed by pathological examination using 860 transverse sections. Results: The distribution of calcified area per vessel area is significantly higher in PTAs than in ATAs by the soft X-ray radiography images (ATAs, 48.3% ± 19.2 versus PTAs, 61.6% ± 23.9; p &lt; 0.05). Morphological and immnunohistological examination revealed eccentric plaque with necrotic core and macrophage infiltration was prominent in ATAs than in PTAs(ATAs, 48.3% ± 19.2 versus PTAs, 61.6% ± 23.9; p &lt; 0.05) (ATAs, 48.3% ± 19.2 versus PTAs, 61.6% ± 23.9; p &lt; 0.05). Moreover, thromboembolic lesions were frequently identified in PTAs than in ATAs (ATAs, 11.1% versus PTAs 15.8%; p &lt; 0.05). The proportion of intimal calcification area and medial calcification area were significantly higher in ATAs and PTAs, respectively (intima; ATAs, 0% [0-16.8] versus PTAs, 0% [0-11.7%]; p &lt;0.05, media; PTAs, 38.2% versus ATAs, 15.7%; p &lt; 0.05). Conclusions: Histological features were strikingly different among these arteries of the patients with CLI. To clarify the pathological features of CLI may contribute to establish the therapeutic strategy for PAD, particularly below the knee arteries.
Abstract 11498: County-Level Social Vulnerability si Associated With Higher Rates of Vascular Amputations in Florida
Authors: Khanjan B Shah, Mohammed Elzeneini, Samir Shah, Adrienne Strong, Yujia Li, Juan Aranda, David E Winchester, Yi Guo, Carl Pepine, Scott A Berceli
Journal: Circulation (2022)

Introduction: Peripheral arterial disease (PAD) is a highly prevalent condition that disproportionately affects patients in minority groups and results in high morbidity and mortality. We seek to determine the association between county-level social vulnerability and vascular amputations in Florida. Methods: We queried the Florida State Inpatient Database (SID) for hospitalizations with a primary diagnosis of PAD between October 2015 and December 2019. We linked patient-level hospitalizations with the county-level social vulnerability index (SVI). We used multivariable regression models to compare rates of major or minor amputations between SVI quartiles for overall SVI and each of the four SVI themes. We also examined in-hospital mortality, 60-day readmissions, total hospital charges, and other secondary outcomes as stratified by socioeconomic status SVI quartile. Results: 38,488 hospitalizations for PAD were identified during the study period. Patients in worse overall SVI quartiles were younger, more likely to be racial minorities (53.7% in 4 th quartile compared to 19.1% in 1 st quartile, p &lt;0.0001), and more likely to have emergent or urgent hospitalizations. Overall amputation rate during hospitalization was 22%. Patients in the worst overall SVI quartile demonstrated higher rates of amputations (OR 1.30, 95% CI: 1.11-1.53) when compared to the most favorable SVI quartile. Socioeconomic status SVI was associated with a higher risk of amputations (OR 1.40, 95% CI: 1.21-1.64) even after adjustment for patient race (OR 1.32, 95% CI: 1.13-1.54). Worse socioeconomic SVI was also associated with longer hospital lengths of stay and higher costs but was not associated with increased in-hospital mortality or readmissions. Conclusions: Patients with worse social vulnerability are more likely to require amputations for PAD in an urgent or emergent clinical setting and have longer lengths of stay and higher costs. Patient socioeconomic status predicts adverse outcomes for PAD even after adjusting for race. Our data suggest a socioeconomic basis for disparities in PAD outcomes. Policymakers should allocate additional resources for areas with worse SVI to design and evaluate interventions to improve care and outcomes.
Abstract 12487: Ex Vivo Assessments of Human Nodular Calcification: Optical Frequency Domain Imaging and Histopathology
Authors: Takahiro Imanaka, Kenichi FUJII, Rin Hoshina, Hirokazu Tanaka, Nagataka Yoshihara, Toshio Kimura, Kojiro Miki, HIROKUNI AKAHORI, Rika Kawakami, Kenji Kawai, Hiroyuki Hao, Masaharu Ishihara
Journal: Circulation (2022)

Introduction: It has been reported that a nodular calcification is associated with a calcified nodule and the reappearance of in-stent failure after percutaneous coronary intervention. Hypothesis: This study evaluated characteristics of nodular calcification on optical frequency domain imaging (OFDI) image in comparison to histopathology. Methods: One hundred and seven matched OFDI and histopathological cross-sections from 13 coronary arteries of 5 human autopsy hearts were evaluated. In histopathological assessment, a nodular calcification was defined as a fragmented calcification with accumulated fibrin. In OFDI analysis, calcification arc, shape of luminal surface, lumen side shape of calcification, irregularity of lumen surface, and irregularity of calcification surface of lumen side were analyzed in each OFDI image. Results: There were 10 nodular calcifications and 97 non-nodular calcifications in histopathological slices. The calcification arc was significantly smaller in nodular calcification than in non-nodular calcification [89.5° (56.4-108) vs. 126° (82.0-190), p =0.02]. OFDI features of a nodular calcification were characterized by a convex shape of the luminal surface (90.0% in nodular calcifications vs. 6.2% in non-nodular calcifications, p &lt;0.01), a convex shape of calcification (90.0% vs 18.6%, p &lt;0.01), an irregular luminal surface (50.0% vs 0%, p &lt;0.01), and an irregular calcification surface of lumen side (60.0% vs 3.1%, p &lt;0.01). Conclusion: This study suggests that OFDI has a potential capability to distinguish between nodular calcification and non-nodular calcification based on angle of calcification, shape and irregularity of luminal surface and those of calcification.
Abstract 12452: Relation of T-Wave Morphology And P-Wave Morphology Parameters With Left Ventricular Fibrosis in Sudden Cardiac Death Victims
Authors: Jenni J Hekkanen, Tuomas Kentta, Mikko Tulppo, Olavi Ukkola, Lasse Pakanen, Juhani Junttila, Heikki Huikuri, Juha Perkiomaki
Journal: Circulation (2022)

Introduction: T-wave morphology and P-wave morphology have been observed to have prognostic significance. However, data about their relation with arrhythmic substrate represented by left ventricular fibrosis are limited. Methods: We evaluated associations of T- and P-wave morphology parameters analyzed from the standard 12-lead ECGs with left ventricular fibrosis in 379 victims of unexpected sudden cardiac death who underwent medico-legal autopsy. Results: T-wave and P-wave area dispersion (TWAd, PWAd) (low values abnormal), non-dipolar components of T-wave and P-wave morphology (T_NonDipolarABS, P_NonDipolarABS) (high values abnormal) all had a significant association with left ventricular fibrosis (p=0.008, p=0.011, p=0.027, p=0.005 between the groups with different stages of left ventricular fibrosis, respectively, post hoc Bonferroni p-values are shown in Figures). Conclusions: Abnormal values of T- and P-wave morphology are associated with arrhythmic substrate represented by ventricular fibrosis partly explaining the mechanism behind their prognostic significance.